| NPI | 1821816638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-09-30 |